Nutritional Assessment

Question 1

What is the A.S.P.E.N definition of malnutrition

Answer 1

acute, sub-acute or chronic state of nutrition, in which varying degrees of overnutrition or undernutrition with or without inflammatory activity have lead to a change in body composition and diminished function

Question 2

What causes a patient to be described as undernutrition, what percentage of patient’s fit this category

Answer 2

Lack adequate calories, protein or other nutrients due to inadequate intake, impaired absorption or altered metabolism/15-60% of hospitalized patients

Question 3

What is kwashiorkor, how fast is it, patient descritption

Answer 3

Loss of visceral protein levels (albumin,leukocytes, granulocytes), preservation of body muscle and fat. rapid onset, shift of fluid into the stomach and legs

Question 4

What is marasmus, how fast is it

Answer 4

Loss of skeletal muscle and body fat but preservation of vsiceral proteins, slow onset

Question 5

How can a patient get a mix of kwashiorkor and marasmus

Answer 5

Patients with a chronic disease also get an acute disease as well

Question 6

What are the steps to the nutrition care process

Answer 6

1) Screening and assesment 2) Diagnosis 3) Intervention 4) Monitoring and Evaluation

Question 7

What is the purpose of nutrition screening

Answer 7

To quickly identify individuals who are malnourished or at nutritional risk and to determine if a more detailed assesment is warranted (done in 24 hours of hospital admission)

Question 8

What is the most reliable and easiest tool to test screen nutrtion

Answer 8

Malnutrition Universal Screening Tool (MUST)

Question 9

What is step 1 of MUST, how are the points distributed

Answer 9

BMI: greater than 20 = 0, 18.5-20 =1, less than 18.5= 2

Question 10

What is step 2 of MUST, how are the points distributed

Answer 10

Weight loss: less than 5% =0, 5-10% =1, greater than 10% =2

Question 11

What is step 3 of MUST, how are the points distributed

Answer 11

Acute Disease: If patient is acutely Ill and there has been or is likely to no nutritional intake for over 5 days = 2

Question 12

Once all the scores are added up how is risk determined

Answer 12

0 equals low risk (routine clinical care), 1 equals medium risk (observe and monitor). 2 equals high risk (treat)

Question 13

For the Malnutrition Screening Tool (MST) what point total is not as risk, at risk

Answer 13

0-1. 2 or more

Question 14

What tool is usually used for the elderly

Answer 14

Nutrition Screening Initiative (NSI)

Question 15

What tool is used for ICU patients

Answer 15

Nutritional Risk Screening

Question 16

What are common elements in these screening tools

Answer 16

Food intake and weight loss

Question 17

How is the NRS used

Answer 17

Left side: Determine highest score for Impaired Nutriotional Satus, Right Side: Determine highest score for Severity of Disease, Add scores from left and right sides (only 1 score from each side), If the total score greater than or equal to 5 parenteral nutrition support should be intitated early (48-72hrs)

Question 18

What are the parameters of nutrition assesment

Answer 18

medical, nutrition and medication history, physical exam, anthtopometric measurements, lab data

Question 19

What are ideal characterstics of nutrition assesment (A.S.P.E.N AND E.S.P.E.N)

Answer 19

Basic hallmark parameters, support a nutrition diagnosis, characterize severity, change as nutrition status changes, evidence based

Question 20

What are the six characteristics that if present cause a diagnosis of malnutrition

Answer 20

Insufficient energy intake, Weight loss, Loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation, decreased functional status (measured by hand grip strength)

Question 21

How many of the characteristics need to be present if there is a diagnosis of malnutrition

Answer 21

2 of 6

Question 22

What would be asked about when assessing insufficient energy intake

Answer 22

Quantity and type of foods, change in eating habits, compare estimated caloric needs with actual intake

Question 23

What should be assessed when asking about weight loss

Answer 23

unintended loss, hydration status needs to be considered, edema or ascites

Question 24

In the physical findings what should be looked at with regards to signs of inflammation

Answer 24

fever or hypothermia, non specific: hyperglycemia and tachycardia

Question 25

Corticosteriods alter what metabolism

Answer 25

glucose metabolism, protein metabolism, fat metabolism, and electrolyte disturbances

Question 26

Protease inhibitors alter what

Answer 26

glucose metabolism, fat metabolism

Question 27

T/F: Labaratory values are used to diagnosis malnutrion

Answer 27

False: There can be markers of severity of inflammation or severity of inflammation

Question 28

What is the calculation for ideal body weight for adult men, adult women

Answer 28

50 kg + {2.3 X (inches over 5 feet)}, 45 kg + {2.3 X (inches over 5 feet)}

Question 29

Indirect calorimetry what is an ideal respiratory quotient, what is underfeeding, overfeeding

Answer 29

VCO2/VO2, .82-.85, less than .7, greater than 1